Provider Demographics
NPI:1356662944
Name:WUNDERLICH, JEANNINE CATHERINE HEISS (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:CATHERINE HEISS
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 CLEAR WATER LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8097
Mailing Address - Country:US
Mailing Address - Phone:239-281-4627
Mailing Address - Fax:
Practice Address - Street 1:6820 INTERNATIONAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7129
Practice Address - Country:US
Practice Address - Phone:239-360-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2811442367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered